Themes Of Shakespeare s Macbeth - 970 Words

Themes of Macbeth (Importance of Act Four Scene Three) What are themes? A theme is a subject of talk, a piece of writing, a person’s thoughts or a main topic. Themes are what make a story or play meaningful. Themes often times have morals or lessons that teach the readers something useful. In the play Macbeth, by William Shakespeare, has several different important themes that influences readers to this day. In Jarold Ramsey’s book Studies in English Literature 1500-1900, he mentions one of the themes in the play Macbeth; â€Å"In Macbeth Shakespeare exposes the ambiguities and the perils in a career premised upon ‘manliness.’† The play and in it’s entirety had countless themes and messages that really do leave a feeling left after watching or reading. More specifically, in act four scene two of Macbeth, there are several important themes that stand out among the rest. Three significant themes that have impacted society in Macbeth act four scene two are; violen ce, ambition and fate. Initially, in Macbeth act four scene two, there is a very serious theme of violence and death. In the following scene Macbeth orders murderers to go to the castle and to kill Macduff’s wife and son. Clearly, after reading what Macbeth’s plans were for Macduff’s family it wasn’t hard to tell what was coming next. At the end of act four scene two the murderer stabs the wife and child to a horrible and undeserved death. â€Å"He has killed me, mother: Run away. I pray you!† (4:2, Line 82) These were theShow MoreRelatedTheme Of Shakespeare s Macbeth And Bronte Wuthering Heights 1095 Words   |  5 PagesDisastrous Love The theme of destructive love within relationships in Shakespeare’s Macbeth and Bronte’s Wuthering Heights are presented through sexism, jealousy, and betrayal. These stories both are portrayed with a theme of destructive love, the tragic love of Macbeth and Lady Macbeth, along with Heathcliff and Catherine. 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In the play Macbeth, Shakespeare expresses the theme of ambition by characterization, conflict and foreshadowing. Shakespeare’s use of characterization helps him communicate the theme of ambition. My noble partnerRead More Literary Techniques in Shakespeares Macbeth Essay1378 Words   |  6 PagesLiterary Techniques in Shakespeares Macbeth Without literary techniques most literature would be colorless. Therefore these techniques are very crucial in producing successful writing. Not only do they create interest, they also help in development of characters, this is especially depicted in the Shakespearean play, Macbeth. The characters developed from the different literary techniques such as irony, paradox, and imagery assist in conveying the many themes throughout the play. In thisRead MoreMacbeth Themes899 Words   |  4 Pages â€Å"What are the major themes in Macbeth† By Connor Maguire William Shakespeare’s Macbeth a play complete with many themes and viewpoints. 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Evaluation Of The And Alcohol Addiction - 929 Words

Johnny Obrien aged 79 years, presented to the Emergency Department after a fall at the RSL, resulting in a laceration on his left elbow which required 3 stitches. He lives by himself with no family close by, and has a history of hypertension and alcohol addiction. Clinical reasoning is a cyclic process, where cues are collected and their data processed to come to a conclusion of the patient situation so that appropriate interventions can be implemented and evaluated through reflective practices which allows for further learning (Levett-Jones 2013). Applying these clinical reasoning skills in practice is important as it has a positive impact on patient outcomes, resulting in less adverse effects due to the detection of patient deterioration throughout this process to ensure safe and effective care (Levett-Jones 2010).Subjective data is information from the patient’s point of view, including their feelings, perceptions and concerns, whereas objective data is information that is observable or measurable (Delmar Cengage Learning 2015). Johnny Obrien’s first set of vital signs at 0500hrs showed a temperature of 37 °C, a blood pressure of 120/60mmHg, a pulse rate of 50 beats/minute and a respiratory rate of 14 breaths/minute. The laceration on his left elbow required 3 stitches, and a simple dressing. His background states he has hypertension and an alcohol addiction. 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Exercise Intervention Anxiety Disorder Health And Social Care Essay Free Essays

string(41) " upset has been estimated to be about 1\." Background: The wellness benefits of exercising are good documented and these effects could assist people with anxiousness upset, affectional and temper upset, and substances abuse. Mental upsets are major public wellness significance. It has been claimed that vigorous physical activity has positive effects on mental wellness in both clinical and nonclinical populations. We will write a custom essay sample on Exercise Intervention Anxiety Disorder Health And Social Care Essay or any similar topic only for you Order Now This paper reviews the grounds for this claim and provides recommendations for future surveies. Aims: To find the mental wellness effects of exercising for people with anxiousness upset, affectional and temper upset, and substances use upset. Search Scheme: Clinical tests on anxiousness upset, affectional and temper upset, and substances use upset ( August 2010 ) were searched based on Cochraine, MEDLINE, PsycINFO, PsycheArticles, Sport Discuss, and PubMed database. Mentions from relevant documents were besides inspected. Choice Standards: All randomized controlled tests comparing any intercession where physical activity or exercising was considered to be the chief or active ingredient with standard attention or other interventions for people with anxiousness upset, affectional and temper upset, and substances use upset. Data Collection A ; Analysis: Citations and abstract were inspected and the quality is assessed, and the informations were extracted. Main consequence: Ten randomised clinical tests met the inclusion standards. Tests assessed the effects of exercising on physical and mental wellness for affective/mood and anxiousness upset, besides the ingestion alteration on illicit drugs and intoxicant. Overall figure go forthing the tests were lt ; 50 % . Most tests use exercising as accessory intervention to standard attention and found important ( p lt ; 0.05 ) consequence of exercising towards better mental province and habit-forming behaviour. Exercise were found to better physical fittingness ( VO2 max = 0.48 mlO2/min ) . There is no important consequence of exercising activity and strength in anxiousness upset but important for depression and substance usage upset ( DASS Cohen ‘s vitamin D = 0.82, Depression: d= 0.57, Anxiety d= 0.92, Stress d= 0.76 ; PDA gt ; 60 % ) . Exercise consequence is higher than standard attention entirely or accessory intervention with speculation. Exercise dose differs for underlying fitness degree, phys ical well-being, and age. Green environment act as accelerator while smoking behavior block the fittingness result. Background There are about 450 million people suffered from mental and behavioural upsets worldwide. One individual in four will develop one or more of these upsets during their life-time [ 1 ] . Mental upsets contribute to about 11 % of 1996 disease load worldwide and it is predicted that it will increase up to 15 % in 2020 [ 2 ] . By looking at local context, about half of Australian population experience mental unwellness at some point of their life-time [ 3 ] , which contribute 13.3 % of the entire state load of disease and hurt in 2003 [ 4 ] . A good mental wellness enable single to manage daily events and obstructions, work on their ends, and map efficaciously in society. Minor perturbations in mental wellness could with detain early intercession will non merely a suffered to the person but besides a load to their households and society well. The economic and personal costs of mental unwellness are besides the major concerned in societal and public wellness. Exercise was believed to heighten person ‘s ability to get by with and pull off their mental upset apart from its good documented physical wellness benefit. Improved quality of life is peculiarly of import for persons with terrible and digesting mental wellness jobs as exercising may relieve depression, low self-pride and societal backdown. A Mental upset is normally determined through clinical diagnosings utilizing the ICD10 or DSM-IV standards. In Australia, anxiousness upset, affectional and temper upset and substances maltreatment are the chief mental upset in this state [ 3 ] therefore will be used in this reappraisal. Description of the status Anxiety Disorder Anxiety upsets are a group of unwellnesss characterized by relentless feelings of high anxiousness, utmost uncomfortableness and tenseness which will significantly interferes with their day-to-day life. Its frequently come out of the blue and presented with intense physical symptoms such as shortness of breath, palpitations, sudating, trembling, feelings of choking, sickness, abdominal hurt, giddiness, pins and acerate leafs, feelings of losing control and/or feelings of impending day of reckoning [ 4 ] . Anxiety upsets besides affect the manner a individual thinks, feels, and behaves. There is different figure of anxiousness upsets which include panic upset, agoraphobia, societal phobic disorder, generalized anxiousness upset, obsessive-compulsive upset, and post-traumatic emphasis upset, which most frequently begin in early maturity and common among adult females than work forces [ 5, 17 ] . It is reported that lifetime prevalence of entire anxiousness upset was 10.6 % – 16. 6 % [ 23 ] . Affectional Disorder Affectional upset characterized by dramatic alterations or extremes of temper which include frenzied or depressive episodes, and frequently combinations of the two. They may or may non hold psychotic symptoms such as psychotic beliefs, hallucinations, or other loss of contact with world [ 9 ] . This upset could be categorized into depression, dysthymic depression, passion, hypomania, and bipolar affectional upset [ 5 ] . For lifetime prevalence, the corresponding pooled incidence rates were 6.7 per 100, 3.6 per 100, and 0.9 per 100 for several major depressive upset ( MDD ) dysthymic depression upset and bipolar I disorder classs [ 16 ] . Substance usage upset Substance usage upset refers to mental and behavioural upset ensuing from psychotropic substance usage such as intoxicant, opoids, others stimulations, psychedelic drugs, baccy and volatile upsets [ 5 ] . The focal point of this paper will look at the survey on intoxicant and illicit drugs. In the short term, the person may comprehend these effects as rather desirable nevertheless, prolonged and heavy use may ensue in physical injury, dependence, and backdown jobs and long term psychological harm or societal injury. This will leads to poisoning, harmful usage, dependance, and psychotic upsets [ 5 ] . Harmful usage is diagnosed when harm has been caused to physical and mental wellness. Dependence syndrome involve strong desire to take substance and trouble in control the usage, physical backdown, tolerance, disregard of alternate pleasance and involvement, and relentless usage despite injury to self and others. Indicate prevalence of intoxicant usage upset has been estimated to be abo ut 1. You read "Exercise Intervention Anxiety Disorder Health And Social Care Essay" in category "Essay examples"7 % globally, which higher rate among work forces 2.8 % to adult females 0.5 % [ 18 ] . While, the load attributable to illicit drugs was estimated at 0.4 % of entire disease load, and economic cost of this harmful drugs dependants and usage in the United State has been estimated to be USD98 billion [ 22 ] . Exercise and mental wellness There is no individual mechanism has yet been found to adequately explicate the diverse scope of mental wellness effects possible through physical activity engagement. The plausible mechanisms for psychological alteration through physical activity and exercising autumn into one of three wide positions as explained by Mutrie ( 2003 ) where there is biochemical alterations such as increased degrees of neurotransmitters ; physiological alterations such as improved thermo-genesis, musculus and cardiovascular map and, suggested psychological alterations such as societal support, sense of liberty, improved perceptual experiences of competency, enhanced organic structure image, self-efficacy and distraction. Important of reappraisal There is a turning acknowledgment that physical activity can heighten mental wellness ( Faulkner 2005 ) . Regardless by this fact, there is still limited grounds to propose the effects of exercising on anxiousness upset, affectional and temper upset, and substances abuse reported in the population characterized by these mental unwellnesss. The intent of this reappraisal is to concentrate specifically on methodologically strict tests in updating current consensus refering the possible function of exercising in bettering the mental wellness of persons with anxiousness upset, affectional and temper upset, and substances use upset. Aim To find the mental wellness effects of exercising programmes for people with anxiousness upset, affectional and temper upset, and substances use upset, and factors that enhance the consequence. Method Types of participants Clinically diagnosed grownup ( aged 17 and supra ) with diagnosed anxiousness upset, affectional and temper upset, and substances abuse utilizing any standards, with any length of unwellness and in any intervention scene. Types of intercessions Physical activity or exercising will be the chief or active elements intercession studied in this reappraisal. As a consequence of most clinical topics is under intervention, intercession in concurrence with others will be considered every bit good. Only intercessions which address mental wellness result of exercising, its dose, and factors attribute to effectiveness will be included. Others exercise survey that potentially discussed the result of heightening physical exercising intercession on mental wellness position will besides will be included for prospective reappraisal. Types of result steps Results were groups harmonizing to appraisals of mental and physical wellness, and were grouped by different upsets, factors attribute to effectiveness, and dose exposure result. The primary result will be mental province mark. Search methods for designation of surveies Search is restricted to English literature will be used as more clip is needed for paper interlingual rendition. Electronic hunts The MEDLINE, PsychInfo, PsychArticles, PubMed, Cochrane, SportDiscuss, SAGE, Springerlink, and JSTOR articles and diary databases ( August 2010 ) were searched utilizing the phrase: [ ( physical* and ( therap* or intercession ) ) within the same field of rubric, abstract or index term Fieldss ) or ( ( fitness* or sport* or gym* or exercis* or * danc* ) in rubric, abstract and index Fieldss Reference ) or ( *exercise* or danc* or physical act* in intercessions field in Study ) ] and besides different phrases for upset studied is added in term, mention and survey field: anxiousness upset ( panic disorder*or agoraphobi*or societal phobi* or generalized anxiousness disorde* or obsessive-compulsive disorde*or post-traumatic emphasis disorde* ) , temper or affectional upset ( depressio*or dysthymi*or mani*or hypomani*or bipolar affectional disorde* ) , and substance usage upset ( alcoho*or cocain*or heroi*or ampletamin* or illicit dru* ) . Data aggregation and analysis In the choice procedure, abstracts of research documents were independently assessed by the hunts for relevancy. When abstract was ill-defined and dissensions occurred, the full study is required and the appraisal procedure repeated. With single-minded dissension, information is extracted from each survey and even from unpublished beginning for the intent of this reappraisal. Surveies are so independently assessed for its methodological quality base on sequence coevals ; allotment privacy ; blinding ; uncomplete result informations ; selective coverage of the consequences ; and any other prejudices identified. The criterion Risk Ratio and Odd ratios at 95 % assurance interval ( CI ) will be used as reading of intervention consequence. As a consequence of uninterrupted informations result in mental wellness tests are frequently non usually distributed, standards for inclusion is used where the standard divergences and agencies for the end point steps on evaluation graduated tables is obtained and the standard divergence ( SD ) , when multiplied by 2 had to be less than the average [ 19 ] . Even though some grade of loss to follow up informations must lose credibleness [ 19 ] , all test in the chief analysis will be included all. Merely survey with result of more than 50 % engagement will be interpreted. Consequence Consequences of the hunt There are about 264 electronics studies inspected and of these, 254 surveies were excluded on the footing of their abstracts. Ten randomized controlled tests ( Carta 2008 ; Jerome 2008 ; Oeland 2010 ; Doyne 1987 ; Kenzor 2008 ; Murphy 1986 ; Sinyor 1982 ; Merom 2007 ; Ng 2007 ; and Brown 2010 ) were included in this reappraisal. Extra 6 surveies ( Mackay 2009 ; Jokela 2010 ; van Hauvelen 2006 ; Perrino 2009 ; Brown 2005 ; and Tart 2010 ) were included for prospective position on exercising effectivity factors that could be used for execution of survey. Included surveies We included ten randomized controlled tests ( Carta 2008 ; Jerome 2008 ; Oeland 2010 ; Doyne 1987 ; Kenzor 2008 ; Murphy 1986 ; Sinyor 1982 ; Merom 2007 ; Ng 2007 ; and Brown 2010 ) . All surveies have been published since 1982 which illustrates turning attending to the function of exercising as a signifier of accessory therapy for the focussed mental unwellnesss. One survey ( Merom 2007 ) investigated the effects of an exercising programme on anxiousness upset where brisk walking exercising and others exercisings were implemented. The 8 -10 hebdomads plan lengths, with exercising dosage of gt ; 30 proceedingss continuance, done five times per hebdomad have shown a singular lessening of anxiousness among patients in the intercession group. Compare with others mental illness surveies ; there are legion surveies on affectional and temper upset. Reviewed surveies shows that exercising does work to cut down depression and anxiousness in bipolar patients with merely one hr per hebdomad of simple group brisk walk exercising for 8 months lengths ( Carta 2008 ) ; and for major depression patient, the positive result were observed after 150 proceedingss per hebdomad group walking for 8 hebdomad length plan. Greater entire clip exposure will give better important result for bipolar patient ( Ng, 2007 ) and the badness of affective/mood psychiatric job does non act upon the exercising result ( Jerome, 2008 ) . Oeland et Al ( 2010 ) have demonstrate that, increased in physical activity will enormously leads towards better organic structure physiology alterations among these patient. Their depression degree were found to hold farther lessening with high degree strength exercising comparison to low denseness exercising at equality d osage ( 4 times per hebdomad with 60 proceedingss continuance ) of exposure ( Doyne 1987 ) . The chief result measured for Drugs and Alcohol usage upset is the per centum twenty-four hours abstention ( PDA ) . Structured group exercising were found leads towards better PDA result as accessory therapy for drugs nuts and alcoholic patients ( Murphy 1986 ; Sinyor 1982 ; Brown 2010 ) at the lower limit of 8 hebdomads intercession ( Murphy, 1986 ) to 12 months intercession ( Sinyor 1982 ) . The effectual dosage reported in these surveies is 20-70 proceedingss exercise modus operandi for the least one time a hebdomad. Unstructured exercising has demonstrated lower result in Kendzor ( 2008 ) and Sinyor ( 1982 ) surveies, verified by their several intercession group and control group result. 1. Methods: All tests were randomized. The continuance of the tests ranged between 8 hebdomads ( Murphy 1986 ) and 24 months ( Ng 2007 ) . 2. Participants: All tests included people diagnosed with anxiousness upsets, affectional or temper upsets, and intoxicant or drugs use upset utilizing DSM-IV standards ( Carta 2008 ; Jerome 2008 ; Oeland 2010 ; Doyne 1987 ; Kenzor 2008 ; Murphy 1986 ; Sinyor 1982 ; Merom 2007 ; Ng 2007 ; and Brown 2010 ) . Merely one survey does non utilize in- or outpatients ( Murphy 2007 ) . Participants ranged in age from 18 to 80 old ages. 3. Setting: Three surveies were conducted in community Centre ( Kendzor 2008 ; Murphy 1986 ; Sinyor 1982 ) , one offered in the university ( Doyne 1987 ) , and the remainder is offered in and outpatient services. 4. Study Size: The smallest sample size is 16 participants ( Brown 2010 ) and the largest figure of participants in sample is 620 people ( Kendzor 2008 ) . 5. Interventions: All survey utilizing exercising as their chief activity used to mensurate the result. The experimental conditions identified in each of the included surveies differed in exercising continuance and strength. The exercising activity strength are from a simple walking to high strength supervised structured aerophilic exercising. Most selected surveies implement consistent continuance of exercising 20-60 proceedingss five times per twenty-four hours for the least 8 hebdomads. Merely good structured supervised intercession implements increase strength ( Sinyor 1982 ; Brown 2010 ) . All exercising programmes were in add-on to participant ‘s usual attention except intercession in Murphy, Pagano and Marlat ( 1986 ) survey. 6. Control intercessions: Standard attention: Participants continued with their usual intervention in Carta 2008, and add-on with Group Cognitive behaviour therapy and merely instruction benefit of exercising for Merom 2007, Oeland 2010, Doyne 1987, Kendzor 2008, Sinyor 1982 and Brown 2010. There are two control groups in Murphy, Pagano A ; Mariat ( 1986 ) survey which one group in speculation intercession while the others were non in either exercising or speculation. These participants were university pupil non with any intervention for inordinate intoxicant consumption. Merely Ng 2007 does non implement control in their intercession. 7. Results: Depression Anxiety Stress Scale ( DASS-21 ) is a 21 point self study questionnaire designed to mensurate the badness of a scope of symptoms common to both Depression and Anxiety. Each point is scored from 0 ( did non use to me at all over the last hebdomad ) to 3 ( applied to me really much or most of the clip over the past hebdomad ) . Merom 2007 and Ng 2007 used this graduated table. World Health Organization Quality of Life BREF Version ( WHOQOL-BREF ) is scale to measure physical wellness, psychological, societal dealingss and the environment on a five-point graduated table where 1 = hapless QofL and 5 = good QofL. Carta 2008 and Oeland 2010 usage this graduated table. The Clinical Global Impression – Badness graduated table ( CGI-S ) is a 7-point graduated table that requires the clinician to rate the badness of the patient ‘s unwellness at the clip of appraisal, comparative to the clinician ‘s past experience with patients who have the same diagnosing. Considering entire clinical experience, a patient is assessed on badness of mental unwellness at the clip of evaluation 1=normal, non at all ailment ; 2, boundary line mentally badly ; 3, mildly ill ; 4, reasonably sick ; 5, markedly ill ; 6, badly sick ; or 7, highly ill. Ng 2007 used this graduated table. The Clinical Global Impression – Improvement graduated table ( CGI-I ) is a 7 point graduated table that requires theA clinicianA to measure how much the patient ‘s unwellness has improved or worsened comparative to a baseline province at the beginning of the intercession. Rated as: 1, really much improved ; 2, much improved ; 3, minimally improved ; 4, no alteration ; 5, minimally worse ; 6, much worse ; or 7, really much worse. Ng 2007 used this graduated table. The Repeatable Battery for the Assessment of Neuropsychological Status ( RBANS ) is a screening battery designed to mensurate attending and treating velocity, expressive linguistic communication, visual-spatial and constructional abilities, and immediate and delayed memory.A Jerome 2008 used this measuring for to records schizophrenic patient activity. Symptoms Checklist-90 ( SCL-90 ) is used as a screening step of general psychiatric symptomatology. It includes dimensions mensurating somatization, obsessive-compulsive, depression, anxiousness, phobic anxiousness, ill will, interpersonal sensitiveness, paranoid ideation, and psychoticism. This was used by Jerome 2008 Center for Epidemiologic Studies depressive graduated table ( CES-D ) is a short self-report graduated table designed to mensurate depressive symptomatology in the general population. The points of the graduated table are symptoms associated with depression which have been used in antecedently validated longer scales.A It was found to hold really high internal consistence and equal test- retest repeatability. Cogency was established by forms of correlativities with other self-report steps, by correlativities with clinical evaluations of depression, and by relationships with other variables which support its concept cogency. This was used by Jerome 2008. Beck Depression InventoryA ( BDI ) is a 21-questionA multiple-choice self-report stock list, used for mensurating the badness ofA depression from a psychodynamicA position. In its questionnaire is designed for persons aged 13 and over and composed of points associating to symptoms of depression such as hopelessness and crossness, knowledges such as guilt or feelings of being punished, every bit good as physical symptoms such as weariness, A weight loss, and deficiency of involvement in sex. Used by Doyne 1987 and Kendzor 2008 Figure1: Methodological quality sum-up: reappraisal writers ‘ judgements about each methodological quality point for each included survey. Adequate Sequence Generation Allocation Concealment Blinding? Incomplete Outcome informations addressed Free of Selective Reporting Free of Others Bias Merom et Al 2007 + + + ? + – Carta et Al 2008 + + + + + – Ng et Al 2007 + ? ? – + – Jerome et Al 2008 + + + – + – Oeland et Al 2010 + + + + + + Doyne et Al 1987 + + + + + – Kendzor et Al 2008 + + ? ? – – Murphy et Al 1986 + + + + + – Sinyor et Al 1982 + + + – + – Brown et al 2010 + + ? – + – Hazard of prejudice in included surveies Allotment: All survey reported as randomized. Blinding: None of the surveies were double-blinded. The reported consequences may overstate estimations of intervention consequence and None of the surveies reported any trial of blinding Incomplete result informations: Most of the surveies have withdrawal from the sample population as the highest reported were in Sinyor ( 1982 ) survey which about 60 % remains in the survey, which were due to self backdown from being participant after undergone first stage of intervention. Selective coverage: Most analyze describe the mean and standard divergence. Others beginning of prejudice: most of the survey have inclination of choice prejudice, measuring prejudice and mistake due to consequence of confusing particularly consequence of group therapy and regular undergone intervention. Discussion Ten surveies were included in this reappraisal. Overall, these surveies showed that exercising therapy can hold an impact on mental wellness results like mental province and general operation with no inauspicious effects. There are assorted surveies looking at the impact of exercising towards anxiousness in non-clinical samples utilizing DASS and SCL-90 inquiries tools, which were excluded for reappraisals apart from the ground of its non-clinical test survey design. Compare to usual intervention entirely and GCBT, prolonged and frequent exercising conducted in group for at least 8 hebdomads were significantly effectual in cut down anxiousness, depression and emphasis among patients diagnosed with generalised anxiousness upset, panic upset, and societal phobic disorder. Similar consequence was observed for bipolar upset and major depression in add-on to their usual intervention, irrespective of the psychiatric status badness and exercising strength ( Jerome 2008 ) . Clinical tests have shown high twenty-four hours abstention from drugs and intoxicant best occurs in good structured, high strength group exercising among alcoholic and drugs addict, in add-on to their usual intervention for the job. Kendzor 2008 survey has demonstrated there was no consequence of single low denseness physical activity towards cut downing the heavy imbibing wont. We could reason that, the minimal effectual dosage for exercising to mental position is 40-60 proceedingss session, repeated 3-5 times per hebdomad for uninterrupted 8 hebdomads continuance. This dose plants for low endurance brisk walking exercising with a proper warming up session. Increases in exercising strength will give better physical fittingness, and ideal weight direction. Type of exercising, its strength, and dosage is modified base on underlying fitness degree and age ( Jerome 2008 ; Jokela 2010 ; van Hauvelen 2006 ; Perrino 2009 ) . Others factors that could impact exercising effectivity is the exercising environment. Mackay A ; Neill 2009 survey shows that there is important relationship between anxiousness alterations and green environment. Exercise strength works for depression ( Brown 2005 ; Jerome 2005 ) and substance usage upset ( Sinyor 1982 ; Brown 2010 ) but non for anxiousness ( Mackay A ; Neill 2009 ) . It is found that smoking behaviour will detain exercising fittingness consequence ( Tart 2010 ) . AUTHOR ‘S Decision Deduction of pattern Peoples with mental unwellness The consequences of this reappraisal indicate that there are assorted benefits of exercising to persons with anxiousness upset, temper and affectional upset, and substance usage upset, which can better constituents of mental wellness by take parting in structured group exercising. Limited figure of surveies on proper strength and dosage of exercising towards the betterment of mental wellness for the different population group and underlying psychiatric jobs has cause troubles for medical practician to come out with clear counsel to the patient. Physician, physical therapist, professional physical trainers, and wellness pedagogue should be consulted for better support and advice towards implementing exercising as intervention intercession. It is clear from this survey that, exercising plants as accessory therapy for identified psychological jobs and high strength exercising work for substance maltreater and depression patient. The best consequence of exercising is that it conducted in group and being supervised. Patient with anxiousness does responds to high strength exercising but the consequence is non much different comparison to low strength exercising. Current guidelines for lifestyle activity and exercising appear do non truly work for the justified mental upsets. Therefore, roll uping 40-60 proceedingss of proper physical activity on most or all yearss of the hebdomad is a good guideline. This should be continued for lower limit of 8 hebdomads for a better mental position result. Cessation of smoke will further guarantee better wellness benefit. For physician, wellness pedagogue, physical therapist and professional physical trainers Regular exercising is known for its physical, mental, and societal benefits. It is a multidimensional attack that requires physician, wellness pedagogue, physical therapist and professional physical trainers to guarantee patients to go and remaining active for its physical and psychological benefit. Proper information guidelines to patients are indispensable in the long tally. Health practicians should besides be equipped with this latest information and every bit good stress on the safety of intercession to avoid negative consequence of exercising particularly muscle hurt if non decently done. Side consequence of medicine and structural barrier for intercession ( socio economic position, substructure ) every bit good as underlying medical status should besides be considered before recommend this intercession to the patients. In others word, exercising intercession is personalized to accommodate single state of affairs. For policy Structural barrier may restrict patient engagement into exercising intercession in mental upset intervention. It is shown from the surveies that patients with mental wellness have better opportunity to better their morbidity when adhere into exercising intercession as accessory intervention for their implicit in psychological jobs. Proper guidelines for wellness practicians and patients are required for better communicating to present the information for both. Multidisciplinary attack should be emphasized in this patterns which could profound positive impact on patients wellness and well-being. More clip is required to present and explicate this message to patient as the plan is personalized to suit single implicit in societal and physical well-being. Policymakers should see the execution of this multidisciplinary programmes approach within their several intervention installations. They should besides see to supply better exercising installations in the community therefore every bit good promotes green environment and the constitution of good structured community exercising group plan for a long term benefit. There is opportunities that uninterrupted exercising plan could be used as bar of acquired mental wellness jobs due to life-style alterations. More grounds on this is required and with such grounds support, cost benefit or cost effectual analysis of preventative exercising intercession in mental wellness could be established. In long-standing, this could be helpful in cut downing pharmaceutical cost for mental wellness in a state. Deduction for research General There are assorted established measuring used in describing mental wellness result therefore cause troubles to compare the survey consequences. It is recommended that in research pattern for mental wellness result, the measuring should be standardized. Specific It is of import in future for us to hold a clear define continuance, frequence and strength of exercising plan for each mental wellness upset ; sing the implicit in medical and physiological well-being of single. Survey on the alterations of fittingness degree due to the intercession is increasingly in patterns, and in any future research it should be reported in the record. Mental wellness is a complex subject where there is no clear cut point of disease and ever presented with a comorbid status of either other mental upset or chronic diseases. This should every bit good to be considered in future research particularly in intercession survey. It is besides a challenge in the research of this country to guarantee the determination is free from cofounding consequence of biological and societal diverseness in the complex planetary society. In the terminal, with the constitution of complete survey in mental wellness country could lend a better theoretical background to explicate the mec hanism of this variegation. This will assist every bit good towards low cost of intervention in mental wellness upset in the hereafter. Mentions 1. World Health Organization ( 2005 ) . Promoting Mental Health: Concepts, Emerging Evidence, Practice. Geneva: WHO Press. 2. Commonwealth Department of Health and Aged Care 2000, Promotion, Prevention and Early Intervention for Mental Health: A Monograph. Canberra: Mental Health and Special Programs Branch, Commonwealth Department of Health and Aged Care. 3. Australian Bureau of Statistics ( 2007 ) . National Survey of Mental Health and Wellbeing: Summary of Results. Canberra: ABS. 4. Australian Institute of Health and Welfare ( 2006 ) . Australia ‘s Health 2006. AIHW. Canberra: AIHW. 5. Australian Bureau of Statistic ( 2008 ) . National Survey of Mental Health and Wellbeing: Summary of Results. Canberra: ABS. 6. Jerome G.J, Young D.R, Dalcin A et.al ( 2009 ) . Physical Activity Levels of Persons with Mental Illness Attending Psychiatric Rehabilitation Programs. Schizophrenia Research. 2009 ; 108 ; 252-257 7. Tart C.D, Leyro T.M, Ritcher A, Zvolensky M.J, Rosenfield D, Smith J.A.J ( 2010 ) . Negative Affect as a Mediator of the Relationship between Vigorous-Intensity, Exercise and Smoking. Addictive Behaviors. 2010 ( 35 ) ; 580-585 8. Mackay G.J, Neill J.T ( 2010 ) . The Effect of â€Å" Green Exercise † On State Anxiety and The Role of Exercise Duration, Intensity, and Greenness: A Quasi-Experimental Study. Psychology of Sport and Exercise. 2010 ; 11 ; 238-245 9. Perrino T, Mason C.A, Brown S.C, Szapocznik J ( 2009 ) . The Relationship Between Depressive Symptoms And Walking Among Latino Older Adults: A Longitudinal, Cross-Lagged Panel Analysis. Aging A ; Mental Health, 14: 2, 211 – 219 10. Doyne, E. J. , Ossip-Klein, D. J. , Bowman, E. D. , Osborn, K. M. , McDougall-Wilson, I. B. , A ; Neimayer, R. A. ( 1987 ) . Runing Versus Weight Lifting In the Treatment of Depression. Journal of Consulting and Clinical Psychology, 55, 748-754. 11. France, C. , Lee, C. , A ; Powers, J. ( 2004 ) . Correlates of Depressive Symptoms in A Representative Sample Of Young Australian Women. Australian Psychologist, 39, 228-237. 13. Bryan A, Hutchison K.E, Seals D.R, A ; Allen D.L ( 2007 ) . A Transdisciplinary Model Integrating Genetic, Physiological, and Psychological Correlates of Voluntary Exercise. Health Psychology, 26, ( 1 ) , 30-39 14. Brown W.J, Ford J.H, Burton N.W, Marshall A.L, Dobson A.J ( 2005 ) . Prospective Study of Physical Activity and Depressive Symptoms in Middle-Aged Women. American Journal of Preventive Medicine, 2005 ; 29 ( 4 ) :265-272 15. Somers JM, Goldner EM, Waraich P, Hsu L ( 2006 ) Prevalence and Incidence Studies of Anxiety Disorders: A Systematic Review of the Literature. Can J Psychiatry, 51:100-113 16. Waraich P, A Goldner EM, A Somers JM, A Hsu L ( 2005 ) Prevalence and Incidence Studies of Mood Disorders: A Systematic Review Of The Literature. Can J Psychiatry. 50 ( 9 ) :569-70. 17. Mutrie N, Faulkner G. ( 2003 ) Physical Activity and Mental Health. In: Everett T, Donaghy M, Fever S editor ( s ) . Physiotherapy and Occupational Therapy in Mental Health: An Evidence Based Approach. London: Routledge,82-97. 18. Faulkner G, Taylor AH. Exercise, Health and Mental Health: Emerging Relationships between Physical Activity and Psychological Well-Being. 1st Edition. London: Routledge, 2005. 19. Altman DG, Bland JM. Detecting Lopsidedness from Drumhead Information. BMJ 1996 ; 313:1200. 20. Van Heuvelen MJ, Hochstenbach JB, Brouwer WH, de Greef MH, Scherder E ( 2006 ) Psychological and Physical Activity Training for Older Persons: Who Does Not Attend? Gerontology. 52, 6, 366-75 21. Carta MG, Hardoy MC, Pilu A, Sorba M, Floris AL, Mannu FA, Baum A, Cappai A, Velluti C, Salvi M ( 2008 ) Bettering Physical Quality Of Life With Group Physical Activity In The Adjunctive Treatment Of Major Depressive DisorderA , Clinical Practice and Epidemiology in Mental Health. 4 22. Murphy TJ, Pagano RR, Marlatt GA ( 1986 ) Lifestyle Modification With Heavy Alcohol Drinkers: Effectss Of Aerobic Exercise And Meditation. Addictive Behaviors. 11, 2, 175-86 23. Merom D, Phongsavan P, Wagner R, Chey T, Marnane C, Steel Z, Silove D, Bauman A ( 2007 ) Promoting Walking As An Adjunct Intervention To Group Cognitive Behavioral Therapy For Anxiety Disorders: A Pilot Group Randomized Trial. Journal of Anxiety Disorders 22 ; 959-968 24. Ng F, Dodd S, Berk M ( 2007 ) . The Effects of Physical Activity in the Acute Treatment of Bipolar Disorder: A Pilot Study. Journal of Affective Disorders.101 ; 259-262 25. Oeland AM, Laessoe U, Olesen AV, Jorgensen P ( 2010 ) Impact Of Exercise On Patients With Depression And Anxiety. Nord J Psychiatry. 64:210-217. 26. Kendzor DE, Dubbert PM, Olivier J, Businelle MS, Grothe KB ( 2008 ) The Influence Of Physical Activity On Alcohol Consumption Among Heavy Drinkers Participating In An Alcohol Treatment Intervention. Addictive Behaviors. 33 ; 1337-1343 27. Sinyor D, Brown T, Rostant L, Seraganian P ( 1982 ) The Role of a Physical Fitness Program in the Treatment of Alcoholism. Journal of Studies on Alcohol. 43 ; 3. 28. Brown RA, Abrantes AM, Read JP, Marcus BH, Jakicic J, Strong DR, Oakley JR, Ramsey SE, Kahler CW, Stuart GL, Dubreuil ME, Gordon AA ( 2010 ) A Pilot Study Of Aerobic Exercise As An Adjunctive Treatment For Drug Dependence. Mental Health and Physical Activity. 3 ; 27-34 29. Jokela M, Manoux AS, Ferrie JE, Gimeno D, Akbaraly TN, Shipley MJ, Head J, Elovainio M, Marmot MG, Kivimaki M ( 2010 ) The Association Of Cognitive Performance With Mental Health And Physical Functioning Strengthens With Age: The Whitehall Ii Cohort Study. Psychological Medicine. 40 ; 837-845 How to cite Exercise Intervention Anxiety Disorder Health And Social Care Essay, Essay examples

Preoperative Preparation Elective Laparoscopic †MyAssignmenthelp

Question: Discuss about the Preoperative Preparation for Elective Laparoscopic. Answer: Introduction In this essay, there will be a study of the perioperative care of the patient with laparoscopic left hemicolectomy surgery. The key patient safety during the pre-operative, intraoperative and postoperative phase supports the positive outcomes. Improper measures of the safety, communication and the team issues are the causative factors for the higher morbidity and high mortality within the operated patients (Han and Min, 2016). Thus, there is the huge importance of the proper management of the perioperative journey by the providing proper safety, communication and the management of the team issues. In this report, there is a case study on the laparoscopic left hemicolectomy. The patient perioperative journey will be detailed from the admission to the hospital till the discharge of the patient from the post-operative department (Han and Min, 2016).. The essay will properly explore the aetiology and physiological process of the disease and patient predication for the justification treat ment's surgical course, the negative impact of the surgery and the related care, safety, issues during the perioperative journey of the patient. The essay will explore the actual or the potential safety, team issues and communication that arise during the care of the perioperative condition and explore the impact of the above on the patient health outcomes. The colectomy is the surgical removal of a section of the bowel or the large intestine. These types of surgeries are done for the treatment of the bowel diseases such as ulcerative colitis, crohns disease or colon cancer. The symptoms of the bowel diseases include constipation, diarrhea, nausea, abdominal cramps, weakness, fever, chills, weight loss, and loss of the appetite or bleeding or there may be no symptoms that are why screening is essential. Colorectal surgery is generally performed for cancer and other pathological condition of the colon (Voron, Douard and Berger, 2016). In spite of the noteworthy advancement in surgical technique such as laparoscopic and evaluation of the multidisciplinary recovery plans, the morbidity rate, and the mortality rate is much higher and vary amongst the various surgical centers. The scoring system that is used and assessment of the capacity of the functionality may support the identification of the patients with high risk and with the predicat ion of the complications. There is a necessity to have the understanding of the factors affecting stress response suppression, optimum fluid therapy, and the pain management. Anesthesiologists are the people that significantly contribute the enhanced recovery and improvement of the perioperative care quality (Voron, Douard and Berger, 2016). Laparoscopic left hemicolectomy: In the case, 69 years man is scheduled for the laparoscopic left hemicolectomy with positive FOB test. Colorectal surgery (CR) for the diverticular, inflammatory diseases or cancer is the surgery that is associated with the high risk. For colorectal surgery, other indications include iatrogenic injury or perforation, ischemic colitis or volvulus (Voron, Douard and Berger, 2016). For the positive perioperative outcomes and management of successful anesthetic, a knowledge of the basic science that is specific for the CR surgery such as colonic blood flow, stress response, preoperative assessment, and pain and fluid management is essential. In addition to above enhanced recovery, evidence-based principles and multidisciplinary team works can potentially support in minimizing the complications incidences (Voron, Douard and Berger, 2016). There are significant numbers of the patient over 75 years suffered from rectal cancer. The patients general fitness is a good predicator of after surgery outcomes for the CR cancer than the age of chronology. Electrolyte imbalance, anemia, nutritional deficiency and weight loss should be recognized and corrected in the preoperative care. In the elective cases that underwent non cancer surgery, the detailed medical problem evaluation and treatment are necessary. However, in the case of the patient that require urgent or cancer surgery, time is very limited (Voron, Douard and Berger, 2016). During the emergency surgery, the main objectives are the identification of deterioration function of the vital physiological organ and their main cause such as hypovolemia and sepsis. Clinical examination, history, monitored parameters review, and the laboratory investigations are necessary to judge the problem severity. Respiratory and cardiac diseases are common among the patients those are undergoing the major colorectal surgery during the preoperative periods. CPET-cardiopulmonary exercise testing suggests as the integrated objective of functional reserve measurement and helpful in the determination of complications and resulted in outcomes (Mekhail et.al, 2011). The CPET results have high prediction value for the patients those are at the risk of development of cardiopulmonary complications during the postoperative period. The CPET also found to be useful for the prediction of the death risk with no ischemic heart disease history or the risk factors for the same (Poylin et. al, 2014). Various types of risk indicators and scoring systems are being used for stratification of risks for the patients those are going on the gastrointestinal surgery. The indicators for the clinical risks are consequents of history, physical examination, functional capacity, serum makers and specific variables to surgery for example; surgery emergency (Mekhail et.al, 2011). In 1991 1996, there was the development of the POSSUM-The physiological and operation severity score for the morbidity and mortality Enumeration and Portsmouth (Mekhail et.al, 2011). The scoring system based on POSSUM predicts the outcomes and the complications. The CR POSSUM that is specific special uses the ten measures of which six are physiological and four are operative is easy to use, accurate and validated (Mekhail et.al, 2011). On comparison, a scoring system based on POSSUM with ACPGSI that is Association of Coloproctology of Great Britain and Ireland, it was found that ACPGSI and CR-POSSUM are best predicato rs of mortality than POSSUM and the P-POSSUM (Mekhail et.al, 2011). In the US, there is the application of NSQIP-National Surgical Quality Improvement Programme for the provision of risk adjustment in the 30 days outcome data, but it is less accepted by the other health providers. In the case study, the patient is undergoing the surgery due to 4mm adenocarcinoma on the left descending colon and the patient was diagnosed by the General Surgeon with adenocarcinoma and booked for the surgery (Mekhail et.al, 2011). For the preoperative preparation, the review of more than 3000 patients concluded that aerobic and anaerobic antimicrobial prophylaxis reduces the infection at the surgical site by 75%. The patient with Crohns disease may intolerant to enteral diet (Daniels et. al, 2013). Status of poor nutrition especially with hypoalbuminemia is being associated with postoperative complications enhancement such as increased hospital stay and infections. Preoperative loading of carbohydrates orally supports the reduction of preoperative discomfort, insulin resistance postoperative, postoperative vomiting and nausea, loss of the muscle mass and improvement of the muscle strength (Daniels et. al, 2013). Chewing of gums mimics feeding, promotion of the peristalsis through hormonal and neural mechanisms that increase the gastrointestinal juices secretion and colon motility and reduction of paralytic ileus postoperative (Poylin et. al, 2014). Modification of the stress responses can be easily achieved through absence or presence of peritonitis, nutritional support preoperative, anesthetic agents intraoperative use and employment of anesthetic techniques, adjuvants preoperative use such as the use of alpha agonists and beta-blockers, postoperative analgesic and patient pathway may cause (Daniels et. al, 2013). During CR surgery, the surgical issues that affect the stress response are open surgery duration, surgery urgency, laparoscopic techniques and blood loss and transfusion amount. Associated stress responses are fatigue, bowel dysfunction postoperative, delay in wound healing, a complication associated with infection such as anastomotic leak, wound infection and the cardiopulmonary complications. In cancer patients, there will be delayed recovery and metastasis increased susceptibility and some long term side effects (Mufty et.al, 2012) Suppressed immune function recovery is faster in the laparoscopic surgery and influences the cancer surgical patients recurrence. There are several strategies that counteract the stress response such as shortening of the fasting periods, nutritional support use and glycemic control, epidural analgesia and laparoscopic surgery (Mufty et.al, 2012) Researchers had found that there are no differences in the inflammatory responses in the patient undergoing CR cancer surgery, they receive either intravenous anaesthesia; remifentanil and propofol or the inhalational anesthesia; fentanyl and sevoflurane. Researchers revealed that plasma concentration of the cortisol and epinephrine were tremendously lower and T-cells and lymphocyte numbers were expressively higher during the epidural anesthesia. During the surgery, systemic lidocaine has anti-inflammatory activity and also supports the suppression of the stress response in the patients those are intolarent to epidural anaesthetia (Mufty et.al, 2012) Methyl Prednisolone also helps in the modification of the stress response and improvement of the postoperative pain and pulmonary function and reduction in length of hospital stay. During the Laparoscopic surgery, dexamethasone administration in dose 8 mg supports lower interleukin-6 and interleukin-13 concentration peritoneal on the first day and significant reduction of postoperative fatigue. Flubiprofen, Parecoxib, and pentoxiphylline (NSAID) are also very useful as the multimodal approach markedly enhances recovery and reduce stress after CR surgery(Chow, 2011).. For the preoperative management of the patient, the team should take the proper measures and treatment that can reduce the later problems(Chow, 2011). These preoperative treatments should be properly communicated with the intraoperative and postoperative team as the preoperative care favors the patient health improvement rapidly after surgery. In the case, the preoperative care team did not properly handover the patient history, preoperative treatment, and consent to the intraoperative team (Chow, 2011). The first legal potential issue regarding the case is that the preoperative care team has handover the consent that is without the signature of the patient and also the patient has little knowledge about the preoperative assessment. If during surgery, any type of miss happening may occur that can create legal issue without patient consent. It is a key responsibility of the preoperative team to properly clear the preoperative assessment procedure and also the anesthetic procedure to the patients before surgery (Shin, 2012). According to the polices, there should be active involvement of the patient during identification of validation of procedure and consent(Parker, 2016). There is a vital role of patient involvement, if there is miscommunication between health care professional and patient then it will lead to increase in risk potential adverse outcomes of the patients that will be associated with the errors in the procedure (Parker, 2016). There should be confirmation of the patients consent through signature and also the patients dual identity should be confirmed by the band. Here the associated risk is the improper documentation of the patient. After the patient identification, then there is conductance of the anesthetic assessment. At this stage, there is potential safety risk related to the anesthesia management, airway management, and intraoperative management were observed (Schwartzberg, 2017). The perioperative anesthetic management goals are the minimization of immune responses and stress maintenance, multimodal analgesia, electrolyte and meticulous fluid therapy, and postoperative gut dysfunction prevention. As in the preoperative care treatment and care support the positive outcomes in the management of above factors (Schwartzberg, 2017). Hypothermia is the condition that causes unwanted systemic changes that includes stress response exaggeration and immune function suppression in the patients that underwent the CR surgery. Active thermoregulation should be carried out during laparoscopic surgery as it cannot be maintained after surgery by bowel exposure reduction (Schwartzberg, 2017). During Laparoscopic surgery, p hysiological changes lead to cardiorespiratory problems. Patients position should be maintained carefully during surgery for the prevention of complication that is position-related. In the laparoscopic surgery case, epidural analgesia may be valuable if the patient substantial respiratory disease during preoperative condition. It is significant to insert the epidural catheter if there are chances of conversion to open surgery(Kim and Ogawa, 2012).. The regional anesthesia such as a combined technique that is spinal-epidural is possible for the resection of low anterior of the rectum. The intraoperative thoracic epidural analgesia and anesthesia is associated with an increase in CBF and good gastrointestinal recovery (Kim and Ogawa, 2012).. Epidural analgesia and pain control does not affect the recurrence of the CR cancer. After the establishment of spinal anesthesia by heavy 0.5% fentanyl and bupivacaine, 0.5% isobaric bupivacaine is recommended for the extension of spinal anesthesia. Though, the microcatheter was detached at the surgery ended(Kim and Ogawa, 2012).. Several types of research have shown that the management of hemodynamics reduces the gastrointe stinal complications that are postoperative (Sumi, 2013). For the achievement of the end points fluids inotropes of fluid alone are recommended. Oxygen saturation changes in the CNS, during the intraoperative and postoperative period, leads to complications(Sumi, 2013). Oxygen saturation 73%, during the intraoperative period, is able to prevent the complications. Dopexamine preoperative use improves the circulation is a controversial statement. In the case, there is lack of the intraoperative team communication as most of them are unfamiliar and less experienced (Sumi, 2013). The team consists of the anaesthetic nurse, the scrub and circulating nurse, the anaesthetist and the surgeon. The surgeon has experience of 25 years with the surgical procedure and the anaesthetist is trainer registrar that was supervised by the consultant that is from a different hospital and visited from last 7 years. The anaesthetist and the surgeon have not worked together previously (Sumi, 2013). The scrub nurse is also less experienced and the circulating nurse who has experience is supervising the RN that is a beginner. As the whole team has less experience so they have less knowledge of the policies and safety risks and the experienced team members lacks communication as they are less familiar. Thus, the key safety potential that the team should communicate properly before surgery for their management, are not communicated properly due to time shortage and communication gap (Wang et al., 2016). Due to the communication gap, the scrub nurse left the light source on the patient's drapes that have a risk of fire. After the surgery, the anaesthetic registrar is worried about the aspiration as the patient has the problem of coughing and slight regurgitates After the whole surgery, the last procedure is time out. This procedure requires the active involvement of all team members, communication, and participation that is essential for safe surgery. After the intraoperative management, the surgical team should properly handover the patient to the PACU team. But in the case, the intraoperative team did not properly handover the patient to the nurse and nurse complained about it to the head nurse. According to the pain protocol, medication chart is followed and the patients vital signs were within the limit but he is complaining of pain and vomiting episodes. Because of the patient discomfort, the registrar was called upon to see the patient and he recommended the medication and overnight stay in HDU but the patient discharge time was after 2 hours and he is just sedated. The nurse was relieved by the other in the afternoon (Wang et al., 2016). The key potential issue in the postoperative care is the communication gap between the intraoperative and postoperative care team because of which the patient faced the discomfort, nausea, and pain and the longer stay in the hospital. Thus, during the postoperative care, the nurse should be properly handover by the anaesthetic registrar (Wang et al., 2016). By adoption of the evidence based practices in perioperative period can enhance the recovery after laparoscopic surgery. This practice is designated as fast track or enhanced or accelerated recovery after surgery (Hu, Zheng and Li, 2017). The pathway for recovery, enhanced or conventional can be managed by the multidisciplinary teams that include surgeons, anesthesiologists, nursing staff, acute pain team, nutritional experts, physiotherapists, and pharmacists. ERP is related to postoperative morbidity reduction (Hu, Zheng and Li, 2017). Despite, it does not lead to mortality reduction. It is recommended to decrease the hospital stay length. The ERP aim is the reduction of perioperative organ dysfunction and stress associated bowel by the incorporation of the multimodal approach (Hu, Zheng and Li, 2017). The postoperative therapy for the fluid maintenance considers the requirements, pathological changes and losses associated with CR surgery. During the postoperative segment, restrictive therapy for fluid management has shown beneficial results (Kalady and Church, 2014). There are several advantages of early enteral diet such as improvement in intestinal anastomoses healing, improvement in colon intake, positive nitrogen balance, and preservation of functionality of gut barrier, improvement in calorie intake, infection complications reduction, reduction in insulin resistance and hyperglycemia, reduction in septic complication and reduction in hospital stay length. It is safer and effective than TPN that requires the central line (Kalady and Church, 2014). After the surgery, thoracic epidural analgesia is advised. For the postoperative pain, intrathecal analgesia, pain-controlled analgesia, wound infiltration; wound infusion, systemic lidocaine infusion, and transverses abdominis plane are used (Kalady and Church, 2014). Opioids are less recommended as they have side effects such as vomiting, nausea, bowel motility inhibition and constipation and their use lead to delayed bowel function return and intake orally aylimopan; a peripheral antagonist showed the reduction paralytic ileus duration after CR surgery (Kalady and Church, 2014). There is a risk of anastomotic leak after the use of inhibitors of cyclooxygenase 2 (Han and Min, 2016). However, NSAID is the part of the multimodal approach. Other analgesics such as gabapentin, tramadol, and ketamine are not recommended as they are used in the routine recommendation. For the laparoscopic surgery, there is no evident analgesic method (Daniels et. al, 2013). Same benefits may not be obtai ned from the epidural analgesia as in the open surgery. Epidural analgesia is benefitted, if the patient has pulmonary morbidities in the preoperative conditions and also if the surgery is converted to open surgery. One of the recent studies has shown that there is the earlier return of the bowel function through IT analgesia as compared to the epidural analgesia. Some reported also shown faster recovery with the epidurals after the laparoscopic surgery (Han and Min, 2016). Conclusion In the last, it is concluded that the perioperative care includes preoperative, intraoperative and postoperative care. If the key issues and problems associated with the perioperative care should be properly maintained during the perioperative care then this will lead to lower morbidity and mortality after surgery. In preoperative care if the antibiotic prophylaxis, immune and stress management has been done, in the intraoperative management, if position, hyperthermia, proper anesthetic therapy and in the postoperative management, diet and fluid management, pain management can be done properly then this help in the faster recovery and reduce the hospital stay of the patient. In the case, there is a number of the key safety potential that was by not fulfilled by the perioperative team due to lack of communication, experience and less practice of the policies regarding the perioperative care. If all of them communicate properly for the patient care and multimodal approach for the patie nt care then recovery of the patient can be assured to the maximum extent. CR surgery has significant mortality and morbidity. As in above case, there is communication gap and less concentration on the potential and principles, there is increased morbidity and long stay of the patient in hospital after surgery. 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